Thursday, February 29, 2024

Southern Fury

Following strong opposition from southern states, the NMC has suspended its decision to limit the number of MBBS seats to 100 per 10 lakh population in every state

Following strong opposition from southern states, the country’s top medical education regulator, the National Medical Commission (NMC), has gone back on its decision to restrict the number of MBBS seats to 100 per 10 lakh population in every state. The new regulation, which was notified on August 16, had barred all five southern states from increasing their medical seats for the next academic session (2024-25).

According to media reports, at least 13 states and UTs, including all five southern states of Tamil Nadu, Andhra Pradesh, Telangana, Karnataka and Kerala, have more than 100 seats per 10 lakh population. The new NMC norm would have directly affected them. 

The Under Graduate Medical Education Board had issued Guidelines under Regulation 10 of the Establishment of New Medical Institutions, Starting of New Medical Courses, Increase of Seats for Existing Courses & Assessment and Rating Regulations 2023 and Regulation l9 of the Graduate Medical Education Regulations 2023.

According to the notification, “these regulations are to prescribe for a medical college and Medical Institution approved for admissions of MBBS students annually, the minimum requirements of accommodation in the college and its associated teaching hospitals, staff (teaching and technical) and equipment in the college departments and hospitals”. The regulations were meant to be applicable to medical colleges being established from 2024-25 onwards. 

Some of its provisions were:

(1) Applications for establishing new undergraduate medical education colleges shall be allowed only for 50/100/150 seats.

(2) Only colleges meeting these requirements shall be eligible for continuing their admission of permitted/recognised number of MBBS students from 2024-2025.

(3) Colleges seeking an increased number of seats cannot exceed a total of 150 MBBS.

(4) Colleges seeking an increase in seats shall have admitted batches fulfilling all the criteria for the preceding academic year and also shall be fulfilling all the requirements for increase in seat capacity.

(5) With the exception that colleges who have applied for the academic year 2023-24 for increased seats, but failed to get it, can ask for the same number (totalling 200 or 250) that was in their previous application.

(6) After 2023-24, a letter of permission for starting a new medical college shall be issued only for an annual intake capacity of 50/100/150 seats, provided that it follows the ratio of 100 MBBS seats for 10 lakh population in that state/UT.

Every hospital seeking permission to start a medical college after the publication of this amended regulation shall comprise the medical college, attached teaching hospital/(s) and hostels for the students and interns, with or without the residential area for faculty and other staff. The medical college, hostels for students/interns and the teaching hospital/institution shall be either in a unitary campus or a maximum of two campuses. Each unitary campus shall have adequate constructed area on the land, as per the prevalent building norms, belonging to the college management or if on lease, at least for a period of 30 years on lease.

If there are two plots/campuses, then the college shall be in a single plot. The distance between the plots of the college and hospital shall have a travel time of a maximum of 30 minutes. The hospital shall have at least 220 beds. There should be adequate accommodation for the principal/dean, college council, academic and examination sections, accounts and other administrative offices (as per the need), the medical education unit and the server room for the computer network. The college council shall comprise the head of departments as members and the principal/dean as chairperson.

The council shall meet at least four times in a year to draw up the details of curriculum and training programmes, enforcement of discipline and other academic matters. There shall be a central library (preferably air-conditioned) with good lighting and adequate space for stocking of books and journals.

However, on August 23, the NMC put on hold its notification. The new guidelines, the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023, had made it mandatory for doctors to only prescribe generic drugs. The NMC in its latest notification further said that Registered Medical Practitioners (RMP) will have to follow the rules and regulations notified in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002.

On August 2, the NMC had passed the following guidelines:

  • Every self-employed RMP shall display the unique registration ID assigned to him by the Ethics & Medical Registration Board in his prescription, certificate and money receipts given to patients. Employed RMP shall get a seal made by the employer for displaying the unique registration number below the RMP’s signatures.
  • The RMP shall display as suffix to his name only NMC recognised and accredited medical degrees/diplomas as provided in the nomenclature of the regulations and listed on the NMC website. RMPs qualified abroad and seeking registration to practice after clearing FMGE/NEXT exam must use NMC-approved equivalent medical prefixes and suffixes to provide clarity to patients and the public at large.
  • RMP shall not claim to be a clinical specialist unless he has NMC recognised training and qualification in that specific branch of modern medicine.
  • Every RMP shall practice the system of medicine in which he has trained and certified (for this purpose referred to as modern medicine or allopathic medicine) and shall not associate professionally with any unqualified person to perform any treatment, procedure or operation.
  • The RMP shall not employ any healthcare professional who is neither registered nor trained under the relevant medical acts. If he employs any such assistants, the ultimate responsibility rests on the self-employed RMP or the RMP responsible for admi­nistration and recruitment in case of hospital practice.
  • Consultation fees should be made known to the patient before examination or treatment. A reasonable estimation of the cost of surgery or treatment should be provided to the patient to enable an informed decision. RMP can refuse to treat or to continue to treat a patient if the fees, as indicated, are not paid. At the same time, this does not apply to doctors in government service or emergencies, but the doctor must ensure that the patient is not abandoned. 
  • RMP shall not solicit patients directly or indirectly or as a part of the group of RMPs, or institutions or organisations or hospitals or nursing homes, or corporate hospitals established, owned, controlled, or maintained by the appropriate government, local authority, trust, whether private or public, corporation, co-operative society, organization or any other entity or person.
  • Every RMP should prescribe drugs using generic names written legibly and prescribe drugs rationally, avoiding unnecessary medications and irrational fixed-dose combination tablets.
  • A RMP shall not directly or indirectly participate in any act of division, transfer, assignment, subordination, rebating, splitting, or refunding of any fee for diagnostic, scanning, medical, surgical, or other treatment. These provisions shall apply with equal force to the referring, recommending, or procuring by a RMP of any patient, specimen, or material for diagnostic purposes or other studies/work. However, nothing in this section shall prohibit payment of salaries by a qualified RMP to another duly qualified person rendering medical care under his supervision. RMP shall not use online forums or agents for procuring patients.
  • An RMP individually or as part of an organisation/association/society, etc shall not give to any person or companies or to any products or platforms, whether for compensation or otherwise, any approval, recommendation, endorsement, certificate, report, or statement concerning any drug brand, medicine, etc.

The NMC’s regulations have been opposed by doctors ever since it was notified. The doctors said that the quality of generic drugs in India is poor and prescribing them may put the patients at risk. 

—By Shivam Sharma and India Legal Bureau

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